how to chose an eldercare facility?

[Omega]

I'm glad you asked this question Spock, such an important decision. Unfortunately for my mother the only choice was the state facility.

 

[DeborahB]

The problems I’ve seen usually are from low staffing. Additionally, if the staffer has a strong foreign accent, some people don’t understand what was said. That’s no reflection on quality, but it affects patient comfort. Night staffing isn’t usually as complete as it should be.

The other thing is continuity of staff and management. If there’s a huge turnover, the residents are often less comfortable. It’s a bad situation, made worse by so many unknowns.

Don’t forget - you can bring in hospice care if it’s suitable. They provide a lot of help.

 

[Texas Proud]

TP-

I’m very sorry to read about your DM’s experience. My DM was in a SNF/memory facility for the last 1+ yrs of her life but, fortunately, we didn’t have such a terrible experience. I’d like to know what your plans are for yourself & DW based on your DM’s experience.

First, we now have my mom in a memory care and she is getting excellent care... after she moved in she improved significantly.... the other place was a SNF and they just did not care...


Since I am 10 YO than DW she will probably have to put me someplace... that is if I live long enough to decline to that level... it will make a difference where we are living... DW wants to move... I do not... sometimes she wants to move overseas... sometimes just Florida or Colorado... we will have to worry about that when the times comes..

 

[Spock]

I did check out both places in my OP with https://www.medicare.gov/nursinghomecompare/search.html?
The PlaceB facility that was an absolute disaster is rated overall 5 stars there!

It's looking like there is no way to pick a good place up front... and even if you do it can degrade quickly with staff turn over.

 

[ncbill]

Yeah, what will you do when the monthly bill steadily increases from about 4K per month for two, to more than $11K for one in the final year?

There is no way to get the bill down, other than move to your home.

Sure they'll need a nursing home?

Just moved my older relative from a nursing home they disliked to their own room in a nearby assisted living.

They are much happier...and a private room in assisted living is less than half the cost of a semi-private nursing bed, even with the significant assistance they need (terminal cancer, on Hospice)

 

[Brat]

Hi, I think it's somewhat of a crap shoot. I'd start by talking to friends/neighbors who might have had someone in a facility. As I walked the halls of the one my mom went to, I recognized many, many local (small town) family names on the residents' doors. Have lunch at the place. See what the food's like. See how the residents are treated. See if they are all on drugs to keep them stable (common in memory care units) - most seemed like zombies to me... Part of it will be cost, part may be location. Think about future care needs. Some places will allow residents to 'age in place', but others will kick them out if they need an IV, or some higher level of care. After my mom broke her pelvis, a national chain (Bro_kdale) would not allow bedrails for her bed to keep her from falling out if she tried to get up. She did fall, but fortunately, we had a mat placed on the floor to cushion the fall. Look at how many staff there are, how accessible they are, and how they interact with patients. The two sides of facility where my mom went were very different places (memory care side vs. assisted living side). My mom's facility steered us to their pharmacy, which charged much higher rates for drugs than a regular pharmacy. I would avoid this, and just have the drugs delivered by your regular pharmacy.

Best of luck and best wishes.

I dealt with the bed rail issue, evidently, it is prohibited by State law because there is a history of patients getting tangled in the rails and injuring themselves. Their solution, providing a cushion mat, is medically acceptable.

I am with you on the pharmacy issue. They are required to have single dose packets, you can't bring the meds in a bottle, so pharmacy options are few.

 

[Spock]

I dealt with the bed rail issue, evidently, it is prohibited by State law because there is a history of patients getting tangled in the rails and injuring themselves. Their solution, providing a cushion mat, is medically acceptable.

I am with you on the pharmacy issue. They are required to have single dose packets, you can't bring the meds in a bottle, so pharmacy options are few.

Yup... bed rails are considered to be constraints... the facility can put up 1 side rail but not both... even on a patient that was recovering from a broken hip.

In addition to the floor cushions they are supposed to lower the bed all the way down... newer beds can lower almost to the floor. Older beds not so far. The downside this is very inconvenient for the patient if they are able to get up by themselves and/or for staff to check on the patient.



In addition to the age of the bed, one facility had cushions 4 inches thick that went on both sides of the bed. Combined with a lowered bed it made for a fall of about 8 inches.


At another facility the cushion was no thicker than those 1/2in thick mats you can get for standing on in your kitchen... the mat got squished up between the 2 beds in a semi-private room and created a trip hazard... which was commented on when one of the staff tripped on it themselves, but nothing was done about it for 24 hours when I pointed it out to the admin as part of a laundry list of other problems.

 

[Fedup]

I did check out both places in my OP with https://www.medicare.gov/nursinghomecompare/search.html?
The PlaceB facility that was an absolute disaster is rated overall 5 stars there!

It's looking like there is no way to pick a good place up front... and even if you do it can degrade quickly with staff turn over.

I noticed one CCRC I passed by recently has a rating of 5 stars. It’s like an apartment unit from the outside.

 

[target2019]

Sure they'll need a nursing home?

Just moved my older relative from a nursing home they disliked to their own room in a nearby assisted living.

They are much happier...and a private room in assisted living is less than half the cost of a semi-private nursing bed, even with the significant assistance they need (terminal cancer, on Hospice)

Should have given more info for the numbers. Costs were going from Independent Living (about $4k) to Assisted Living ($7,5k) to Memory Care (>$10k). I have no information on nursing home.

 

[audreyh1]

I didn’t look at star ratings. My sister and I visited multiple local facilities. They were all small. We moved DD to the best of the lot. He was not interested in moving away.

Being rural, it’s quite inexpensive <$2K per month. Minimal assistance, but they are checked up on, housekeeping, meals, laundry, company at meals, some assistance with mobility, flue shots, etc. 16 rooms, low turnover, everybody knows everybody type small town. Nice place overall. He’s pretty content. He’s had several visitors which is a huge benefit for staying local.

They can facilitate aging in place with sitters, etc.

 

[Fedup]

Should have given more info for the numbers. Costs were going from Independent Living (about $4k) to Assisted Living ($7,5k) to Memory Care (>$10k). I have no information on nursing home.

I would assume nursing home is the stage between Assisted Living to Menory Care. I’m new to all these terms.

 

[target2019]

I would assume nursing home is the stage between Assisted Living to Menory Care. I’m new to all these terms.

I think "nursing home" is a legacy concept.
The three I mentioned, IL, AL, Memory, are in one private facility. CCRC.

Here are some terms:
https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes

 

[audreyh1]

I think "nursing home" is a legacy concept.
The three I mentioned, IL, AL, Memory, are in one private facility. CCRC.

Here are some terms:
https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes

To me - a nursing home is really a kind of hospital - a skilled nursing facility. This assumes the patient needs daily nursing care.

 

[MichaelB]

Geriatric physicians and psychiatrists know which facilities are best and which are the ones to avoid. Visiting assisted living facilities during mealtime can also be very helpful. An active social life in an ALF is important and mealtime is an opportunity to see how many residents are socially engaged. It also gives a sense of overall resident satisfaction.

 

[Spock]

To me - a nursing home is really a kind of hospital - a skilled nursing facility. This assumes the patient needs daily nursing care.

It gets to be a gray area between how much attn/care/services the assisted living will provide or assist with before wanting to move them to SNF. I've found in hunting around that if an inmate can't do transfers (get out of bed, in/out of chair, on-off toilet by themselves), assisted living facilities won't take them.

My in-laws are dealing with an aunt that doesn't really need assisted living, but she is such a PITA wanting attn (she's worn a neck brace for years to get attn, Dr said she doesn't need it) that the facility wanted to boot her out... they ended up letting her stay at increased monthly rate.

 

[Spock]

Several have commented about getting recommendations from discharging hospitals and Drs. I've found the hospital nor the hospital social worker will not give a recommendation. They will only provide a random order list of facilities in the area. When I asked directly "which would you use" I got a "we don't give recommendations".
Likely yet another side effect of living in a society that allows ambulance chaser ads on TV, but on the other hand as rapidly as staff/ownership turns over at some of these places it would be impossible to have a current accurate opinion.

I guess that also answers my own question... if 3-6month old first hand experience with a facility is no longer valid due to staff/ownership turnover, there really isn't much that can be done to select a facility other than to walk a hallway (assuming they don't have any security) to sniff for smells and listen for groaning.


It just seems there should be a better way to handle selecting such an important and expensive service.

 

[JoeWras]

Yep. Recommendations in health care are becoming a thing of the past. That's been my experience of late.


As a matter of fact, after making my decision, the service provider asks who I chose. It usually goes like this: "Oh thank goodness you didn't choose X."


I'm like: "Thanks, I think? So you couldn't have told me to stay away from X in the first place?"